1 in 5 Patients with Erosive Esophagitis Cycles Through PPIs

The use of prescription proton pump inhibitors (PPIs) is common among US patients with erosive esophagitis (EE), but persistence with PPI therapy is low, suggests a study published in Advances in Therapy.

“A subset of patients tended to cycle through PPIs, and these patients had more comorbidities and higher all-cause and EE-related health care costs,” wrote corresponding author Rena Yadlapati, MD, of the University of California San Diego, La Jolla, California, and study coauthors.

The observational study included 158,347 patients with EE over a 12-month baseline period and 36 months of follow-up. Researchers used electronic health record and claims data to analyze the characteristics and health care burden of patients stratified by PPI lines of therapy.

Among patients, 45.4% had 1 line of therapy, 9.5% had 2 lines of therapy, 9.6% had 3 or more lines of therapy, and 35.5% did not fill a PPI prescription over the 4-year study period.

The most common PPIs used were omeprazole and pantoprazole, which made up more than 70% of any line of therapy, according to the study. Persistence with PPI therapy was low, with only 11.4% of patients persistent with their first line of therapy, 12.6% persistent with their second, and 15.6% persistent with their third. Cycling between omeprazole and pantoprazole was frequent.

Over follow-up, all-cause health care costs averaged $16,853 a year, and EE-related health care costs averaged $523 a year, the study found. With each line of therapy, all-cause and EE-related health care costs increased.

Hiatal hernia, peptic ulcer, and Barrett’s esophagus were the most common gastrointestinal comorbidities over follow-up, and dyspepsia and dysphagia were the most common symptoms, researchers reported.

“The percentage of patients with these gastrointestinal-related comorbidities and symptoms increased with an increase in the number of PPI lines of therapy,” the authors wrote.

Reference:
Yadlapati R, Cappell K, Sedgley R, et al. A linked electronic medical record-claims analysis of the clinical and economic outcomes of patients coded for erosive esophagitis in the United States. Adv Ther. 2023;40(12):5489-5501. doi:10.1007/s12325-023-02688-7